MEDICARE: JEFFREY VARKIS BALIGIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1063751329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY VARKIS BALIGIAN

Provider Business Mailing Address
First Line	:	10755 WILDHURST ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-4699
Country	:	US
Telephone Number	:	702-497-7605
Fax Number	:

Provider Business Practice Location Address
First Line	:	2340 PASEO DEL PRADO
Second Line	:	B-D206
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4360
Country	:	US
Telephone Number	:	702-569-4455
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2013
Last Update Date	:	02/06/2013

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